Abstract

Background

Social inequalities in health are a characteristic of almost all European Welfare
States. It has been estimated, that this is associated with annual costs that amount
to approximately 9% of total member state GDP. We investigated the influence of inequalities
in German health care utilization on direct medical costs.

Methods

We used longitudinal data from a representative panel study (German Socio-Economic
Panel Study) covering 1994 to 2010. The sample consisted of respondents aged 18 years
or older. We used additional data from the German Health Interview and Examination
Survey for Children and Adolescents, conducted between 2003 and 2006, to report utilization
for male and female participants aged from 0 to 17 years. We analyzed inequalities
in health care using negative binomial regression models and top-down cost estimates.

Results

Men in the lowest income group (less than 60% of median income) had a 1.3-fold (95%
CI: 1.2-1.4) increased number of doctor visits and a 2.2-fold (95% CI: 1.9-2.6) increased
number of hospital days per year, when compared with the highest income group; the
corresponding differences were 1.1 (95% CI: 1.0-1.1) and 1.3 (95% CI: 1.2-1.5) for
women. Depending on the underlying scenario used, direct costs for health care due
to health inequalities were increased by approximately 2 billion to 25 billion euros
per year. The best case scenario (the whole population is as healthy and uses an equivalent
amount of resources as the well-off) would have hypothetically reduced the costs of
health care by 16 to 25 billion euros per year.

Conclusions

Our findings indicate that inequalities and inequities in health care utilization
exist in Germany, with respect to income position, and are associated with considerable
direct costs. Additional research is needed to analyze the indirect costs of health
inequalities and to replicate the current findings using different methodologies.